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Improved Health Insurance Coverage, Access to Care May Lessen Racial/Ethnic Disparities in Childhood Cancer Survival


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A new study published by Jingxuan Zhao, MPH, and colleagues in Cancer Epidemiology, Biomarkers & Prevention found racial/ethnic disparities in survival among newly diagnosed patients with childhood cancers in the United States, and that area-level socioeconomic status and health insurance contribute to these disparities. The study found that compared to non-Hispanic White patients with childhood cancer, non-Hispanic Black and Hispanic patients had worse survival for all cancers combined, leukemias and lymphomas, brain tumors, and solid tumors. The study was based on data from children (aged < 18 years) newly diagnosed with cancer from 2004 to 2015 in a nationwide hospital-based cancer registry.

Jingxuan Zhao, MPH

Jingxuan Zhao, MPH

To learn more about these disparities, investigators evaluated modifiable factors that contribute to racial/ethnic disparities in childhood cancer survival. They found that survival disparities were reduced after adjusting for health insurance and area-level socioeconomic status separately, and further reduced after adjusting for both together.

Since the 1970s, 5-year survival of childhood cancer has improved dramatically, to 80%, largely driven by the widespread participation in clinical trials, improved supportive care, and the development of new therapies. However, improvements in survival have not been experienced equally in all race/ethnicity groups. For example, clinical trial participation rates have been low for minority children with cancer, which could be possibly explained by barriers resulting from lower socioeconomic status and being uninsured.

Historically, non-White patients with childhood cancer were overrepresented in the lower socioeconomic status stratum, which is associated with problems with health-care access and affordability potentially due to a complex interplay of their parents’ financial status, employment, and health literacy. In this study, non-Hispanic Black and Hispanic patients with childhood cancer were more likely to be uninsured or be covered by Medicaid than non-Hispanic White patients. Being uninsured has been linked to delays in receiving timely care and completing care, and as a result, may lead to worse survival.

“This study suggests that improving health insurance coverage and access to care for children, especially those with low socioeconomic status, may reduce racial/ethnic survival disparities,” wrote the authors. “This continued inequity in health outcomes among children warrants concerted, multifaceted approaches to address and minimize these disparities in the future.”

Disclosure: For full disclosures of the study authors, visit cebp.aacrjournals.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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